Good golly, Miss Molly…

Here’s a 2002 column of hers on the need for health reform. And here’s a 2000 column that mentions her battle with cancer, as part of a witty but accurate review of what works in health reform, and what doesn’t. It also happens to critique President Bush’s health care plan, which doesn’t seem to have changed in seven years–in fact, it seems to have gotten worse…

Just don’t get sickby Molly IvinsSeptember 14, 2000AUSTIN, Texas — When I was in my 20s, the subject of insurance was so vastly boring that it was a way to describe a bad date: “like talking to an insurance salesman.” It’s still sort of like your teeth — something you’d rather not think about but have to take care of — so let’s plunge in.

As Jonathan Cohn pointed out in the May 1 New Republic, the object of health insurance is to get as many people as possible into one big pool, mixing the sick with the healthy. This way, the healthy pay a little more than they otherwise would, but those who get sick pay a lot less.Since everyone gets sick eventually, if only from old age, it works out fairly. Your chances of never being sick a day in your life and then dropping dead of an undiagnosed heart condition at an early age are less-than-lottery-slim. In most advanced countries, this led logically to national health insurance — everybody in the same pool, only one administrative agency instead of hundreds…

As a cancer survivor, I am now part of a network regularly called upon to help raise $300,000 to $400,000 for some individual whose insurance company has found a way to drop her. Always a life at stake. The hundreds of thousands of you who have had your HMOs fold under you know how chancy the present system is.

George W. Bush’s solution is to promote medical savings accounts — MSAs. Individuals buy a cheap insurance plan covering only catastrophic illness and then put money aside, tax-free, to cover their medical bills. If there’s any left over at the end of the year, they get to keep it. The theory is that this will discourage people from spending frivolously on health care.

“In reality, MSAs simply allow people who expect to be healthy to opt out of larger insurance pools,” said Cohn. “Small businesses like the accounts because they transfer the onus for medical coverage more squarely onto individuals. But most experts who have looked at MSAs have concluded that, by further segregating healthy and sick in the health-care market, they make it tougher for people likely to incur high health-care bills to get insurance.”

The other piece of the Bush plan is to set up association health plans allowing small businesses to clump together to buy health insurance as cheaply as the big corporations do.

The Catch-22 is that most states already have small businesses clumped together in an insurance pool. The only difference the Bush plan would make would be to exempt those plans from state regulation — i.e., requirements for minimum benefits like mental-health coverage.The result would be further segregation of health coverage — employees healthy, rates go down; a couple of employees get very sick, rates go up; company can no longer afford coverage, drops policy; end result, more uninsured.

Neither move is going to help the 44 million uninsured in this country, and both are likely to increase their number. This is not a solution. For the uninsured, Bush proposes a $2,000 tax credit per family to allow them to buy their own health insurance — but $2,000 doesn’t nearly cover the cost, and nothing is more expensive than buying health insurance as an individual….

For those whose faith in the free market is religious, this is not something to debate. But even Adam Smith admitted that the free market can’t take care of everything. And one of the things that no country has yet found a way to make it do is health care. The upside to having government as the only insurer is that it’s cheaper because profits don’t enter into it.